5900-70 Qualified Product Information Form for Dehumidifiers

OMB Control No. 2060-0528

Approval Expires XX/XX/XX

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

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Qualified Product Information Form for Dehumidifiers

Office of Atmospheric Programs

­ENERGY STAR^® product information form for use by ENERGY STAR dehumidifier partners

(Companies who have joined ENERGY STAR for dehumidifiers by signing a Partnership Agreement)

You may use this form to report only those products that are sold under the company’s brand name. If your firm sells its models to another company that uses its own brand name, that company must join ENERGY STAR and report its own products. Information from this form will be added to the list of ENERGY STAR qualified dehumidifiers.

Product Contact Information

Company Name:______________________________ (For public requesting product information)

(As listed in Partnership Agreement)

Name: ___________________________

Product Category (please check one)

_____ Standard Capacity Dehumidifier

_____ High Capacity Dehumidifier

Tel:___________________

Fax:___________________

E-mail: ___________________________

BRAND NAME	MODEL SERIES NAME	MODEL NUMBER	PRODUCT CAPACITY (PINTS/DAY)	PRODUCT CAPACITY (LITERS/DAY)	ENERGY FACTOR UNDER TEST CONDITIONS (LITERS/kWh)	DATE AVAILABLE ON THE MARKET

Tested By: (Name of Independent Testing Firm or Self-Tested) ________________________ Date Tested: _____________

Note: testing must be done in accordance with the criteria laid out in Section 4 of the Version 2.0 ENERGY STAR specification for dehumidifiers.

Labeling Requirements

By checking the boxes below, you are confirming that you have reviewed and will meet the labeling requirements outlined in the ENERGY STAR Program Requirements for Dehumidifiers. These requirements include:

 On top/front of the product  On product packaging  On Internet site  In product literature

Please check one or more of the following international markets where these products are sold (if applicable)?

 Australia/New Zealand  Canada  EU  Japan  Mexico  Taiwan

Please list all retailers that carry the product (attach a list if necessary): ________________________________________ _________________________________________________________

__________________________________________________________________________________________________

Please submit your completed Qualified Product Information Forms one of the following ways:

E-mail QPI forms to dehumidifiers@icfi.com

Fax QPI forms to Mehernaz Polad at (202) 862-1144

US Mail/Overnight/Express QPI forms to: Mehernaz Polad, ICF Consulting, 1725 Eye St. NW, Suite 1000, Washington, DC 20006

The public reporting and recordkeeping burden for this collection of information is estimated to average 4.85 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

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ENERGY STAR, US EPA, 1200 Pennsylvania Ave., MC 6202J, Washington, DC 20460 USA

Toll-free number: 1-888-STAR-YES Web site: www.energystar.gov

EPA Form No. 5900-70